18 July 2023

Disease and the "art" of medical illustration


Adolescent with severe untreated leprosy.
Wellcome Library, London

Many thanks to Will Self for cleverly reviewing a book that I would not have otherwise looked at. The medical images in Dr Richard Barnett's The Sick Rose: Disease and the Art of Medical Illustration (2014) were as­t­onishing. The book was sourced from the Wellcome Trust and the pictures ranged from the Early Modern woodcuts, to the colour litho-graphs of the late C19th-early C20th.

Richard Barnett, author of Medical London: City of Diseases, City of Cures (2008), introduced the history of western medical scien­ce. He quoted William Hazlitt's remarks on anatomical illustrat­ion: "The learned amateur is struck with the beauty of the coats of the stomach laid bare, or contemplates with eager curiosity the transverse sect­ions of the brain … And overcomes the sense of pain and repug­nan­ce. It is the same in art as in science."

This tension, between the functionalism of medical illustration and the aesthetic properties of the images themselves, was as present for the modern viewer as it was for Hazlitt – with this added humanitarian twist: whereas from the 1700s well into the C19th, the bodies of those so dissected and displayed were accorded no particular respect. How­ev­er our modern culture of sympathy surely imbues even the most chopped up and diseased of tissues with sensitivity.

The strange, symbiotic relationship between medicine and social opp­res­sion was given full-colour form: by anatomical illust­rat­ions of paupers' and criminals' corpses, AND by what would be regarded as straight forward port­raits of the leprous, syphil­itic, tub­ercular and canc­erous. The juxtaposition of styles of portrait­ure with such extr­eme pathological symptoms created an unpleasant sensation.

Here were ladies' noses eaten away by chancres, or men's foreheads and cheeks covered with warty out-growths. The extent of some of these deformations helped the viewer imagine the horror show that Britain's cities must have provided. There was also a tension between the port­rayals of the disease and of the diseased: some of the details of nec­rotic tissue were so magnified that it was barely human.

Beyond the graphic impact of so much disease and dis­figurement, what distinguished them was an acute paradox: here the styles and modes of bygone eras were used not to make people att­ract­ive or create a picturesque landscape, but to render the pathol­ogical as clearly as possible with a view to instructing physicians.

Forehead Tumors
Wellcome Library, London


The Sick Rose - cholera
book cover


Medical illustration developed with the meth­ods of easel painting, so viewers saw the same stippling and chiaroscuro. But while it was generally known that the early art schools almost always had an anatomy lecturer on their staffs, it was surprising that anatomical and pathological depiction inf­luenced fine art in gen­eral. The use of lurid colour seems to antic­ipate both the Fauvists and the Impress­ionists, while the identific­ation of the body as a site of perversity led to the Sur­r­ealists. Looking upon hands and feet, think of Max Ernst creating strange and post-human landscapes.

These images dated from a time when all methodologies, artistic, med­ical and anatomical, were still a-changing, and as such they presented the viewer with the more unsettling truth about our bodies: that they were/are always a foreign and frightening hinterland.

Writers called this elegantly designed collection of early med­ical illustrations beautifully gruesome. Many of the images eg head of a 13-year-old boy disfigured by leprosy, made most readers close their eyes in horrified fascin­ation. 

Barnett began with a quote from William Hazlitt, written in 1817, at the time that Edward Jenner’s controversial method of vaccin­at­ion ag­ainst smallpox, discovered in the late 1790s, was catching on in Brit­ain. The Compulsory Vaccination Act (1853) made vaccination oblig­atory for all children born in England and Wales. It aroused strong oppos­ition, especially from those unable to afford private vaccinat­ion. Jen­ner was called a money-grabber and quack; in 1862 his statue was removed from Trafalgar Square in central London off to a site in Kens­ington Gardens. 

Each book section was devoted to a group of related dis­eases. They began with skin diseases, followed by leprosy, smallpox, tuberculosis, cholera, cancer, heart disease, venereal diseases, par­asites and finally the fashionable gout of the leisured classes.

 Egon Schiele,
 The Pathological Body, 1910   

Frank Netter
1959 CIBA Collection of Medical Illustrations Vol 3
Etsy

Examine the book’s cover image, depicting a young lovely Viennese woman with disturbingly bluish skin and lips in 1831, during the first European cholera epidemic. Compare this last image, beside her port­rait when she healthy – a standard comparative device in medical ill­ustration.

See epidemiologist John Snow’s 1854 map of cholera incidence in London’s Soho slums, which explained cholera tran­smission as water­borne. But Snow’s discovery had little influence on C19th medicine and public health, in which the miasma theory of air­borne cholera transmission dominated. Even Florence Nightingale, whose 1858 Diagram of the Causes of Mortality of British troops in the Crimean War was included, strongly supported miasma theory.

The social history illustrations eg some morbidly erotic paintings warning against syphilis, were fascinating. But the many images of dis­eas­ed internal organs were probably more interesting for those with spec­ialised medical knowledge. But not interesting now to modern view­ers, apart from cancer, heart disease and gout.




26 comments:

Joe said...

The Compulsory Vaccination Act (1853) made vaccination oblig­atory for all children born in England and Wales, as it should have. It aroused strong oppos­ition, and Jen­ner was seen as a mere money-grabber. I am not surprised; nothing much has changed since.

jabblog said...

Seeing beyond the grotesque to the particulars of a disease is still an important diagnostic skill. The photographer superseded the artist, but all depictions are valuable.

Hels said...

Joe

nod. It may have made sense that not everybody trusted the vaccinations when they were first made compulsory in 1853. In fact vaccination WAS opposed by some individual family and by organisations such as the anti-vaccination leagues. Yet within a decade, when two-thirds of neonates were vaccinated, there was a great fall in the death rate due to smallpox in UK.

What makes less sense is that 1 in 10 primary care doctors do not believe that vaccines are safe, according to a US survey in 2023!! See medpagetoday

Hels said...

jabblog

artists were interested in the human body for centuries, agreed. The body bits originally had to be covered up by artists, but over the centuries, more and more exposure was tolerated. Teachers of physicians and surgeons knew that had to help medical students get familiar with sick patients, so before bodies were made available for anatomy lessons, art works must have been a god-send.

Even if most marks of disease and disfigurement were made less visible in commissioned portraits, all depictions were indeed very valuable.

Parnassus said...

Hello Hels, When I was in London I was lucky to come across (at the Embankment Exhibit Hall) a special exhibit of early écorchés* and medical models, many of them modeled in colored wax and uncannily realistic. Some of these sought to teach basic anatomy, while others were to illustrate diseases. As in these drawings, many of the models, although showing muscles, organs, etc., were posed "artistically," creating a bizarre and as you point out, surreal effect.
.
As a collector of photographs I have seen old medical illustration photographs, which differ from the drawings you are showing to us. Since they show real people, the photos cannot be exaggerated or represent composite cases, and in their startling realism can be even more horrifying. Today we have the Body Worlds exhibit, of real bodies and parts preserved by being plasticized, and these can be upsetting or merely instructive depending on your point of view, but to me they are very much less scary than the old medical models and drawings.
--Jim

*Even the great sculptor Jean-Antoine Houdon, in addition to his busts of Washington and the like, produced his famous 1767 L'écorché:
http://www.artcyclopedia.com/feature-2003-06-Houdon-Ecorche.html

DUTA said...

As far as I can tell, nowadays,deformations and diseased tissues/organs are realistically illustrated, regardless of the visual horror they might elicit in the viewer.

roentare said...

Medicine is art. The graphic images are so real and striking straight through my heart!

Jo-Anne's Ramblings said...

Medical images from way back when are interesting and graphic as well

Hels said...

Parnassus

I had to look this up, so I was thrilled to find that Écorché sits somewhere between art and medicine. While during the Renaissance the first écorchés were used mostly by artists, later they became increasingly popular among medical students as well. Exactly what I cared about, time-wise and medium-wise, thank you!

Plus another thing. Hearing medical information is good, seeing the same information in 2 dimensional drawings and paintings is better and touching the same information in 3 dimensional sculpture is best. Jean-Antoine Houdon was a clever bloke back in 1767.

Hels said...

DUTA

You are correct, of course. Especially since we know that people grossly wounded or diseased used to be cut out from the community into isolated asylums. No medical care, just isolation.

Hels said...

roentare

Right. I always understood that art could be anatomical, but it didn't occur to me until the last few years that medicine could be art. You would enjoy reading The Sick Rose: Disease and the Art of Medical Illustration.

Hels said...

Jo-Anne

I wonder if undergraduate students these days learn anything about the history and art from early medicine on.

Hilary Melton-Butcher said...

Hi Hels - I'm so pleased you found the book via Will Self - fascinating to find out about - I see Richard Barnett has written another on Dentistry ... thanks so much for telling us about them ... I'd love to read them - cheers Hilary

Hels said...

Hilary

great reference, thank you.

Amazon: "Smile Stealers" has beautiful and gruesome technical illustrations and paintings from the Wellcome Collection’s archives, with seven themed articles from medical historian Richard Barnett. It reviews the development of dentistry, going from the very first dentures (Etruscans C7th BCE ); the smile revolution in C18th portraiture; and the role of dentistry in forensic science. Art influenced a number of professions, clearly!

Rachel Phillips said...

Medical illustrators are still in demand in modern medicine and there are a number of post-graduate courses in the UK offering the study of human anatomy and illustration for application today.

Hels said...

Rachel

I had never heard of post-graduate courses for the study and illustration of human anatomy, but it is wonderful. It confirms what the early medical publishers understood when they borrowed body and facial images from mainstream artists, to help in the education of medical students. But now they are not borrowing.. they have created their own learned profession!

Dr Joe said...

To generations of medical students, Frank Netter was magical. He was the doctor who drew the remarkably lifelike images that undergrads all used to learn anatomy, better than cadavers or on CAT scans. Netter studied at the National Academy of Design, where he drew nude figures. At New York’s City College, he drew for the school’s yearbook and spent the summers as an artist. In 1927, he enrolled at New York University Medical College.

His portraits, drawings of body parts and, at the behest of pharmaceutical companies, images of new drugs and how they worked were too vivid to ignore. It was Netter’s relationship with drug manufacturers that propelled forth his career as a medical artist. Over 5 decades, Netter worked with the company to produce the Ciba Collection of Medical Illustrations and the Clinical Symposia, beautifully illustrated books that depicted both normal anatomy and the pathology associated with specific diseases. His 4,000 illustrations also depicted patients (drawn from models) suffering from various conditions. Ciba distributed his illustrations far and wide to medical students and physicians as a marketing tool.

"Frank Netter, MD: The Michelangelo of Medicine"
by Barron Lerner

Hels said...

Dr Joe

If you can still cite Frank Netter as a major artist and author in your undergraduate years (50+ years ago), Dr Netter must have been a very very special anatomy artist. Dr Barron Lerner clearly agreed with you.

Rachel Phillips said...

My one time doctor's father, transplant pioneer Sir Roy Calne, also did anatomy paintings and drawings for his students.

Hels said...

Rachel

you know some wonderfully famous people :) I only distantly know Sir Roy's name from transplant history, but I impressed that he created anatomical works for his students.

That has raised another question in my mind. Do people who work in medicine have talents in the arts that allow them to express their creativity separately? I know many working doctors who are impressive piano players, painters and novelists on weekends.

Hank Phillips said...

That reinforces my weight-loss diet. What rang a bell was the anti-vaxxers (I am suspiciously agnostic, hence hted by both extremes). Their tearing down of statues, even to no fan of political statues, had way too familiar a ring to it.

Hank Phillips said...

At British School I was urged to draw anatomical detail. Many years later a physician whose real job was producing anatomical art complained of losing trade because of computer graphics.

My name is Erika. said...

I haven't heard of this book. It makes me wonder if I'd like it, because it looks fascinating in some ways and rather strange in other ways. I sometimes wonder how accurate these old illustrations are. I think it probably that they look "weird" because of the style of drawing at the time they were made. I still like to read about books of all kinds, whether I'd read them or not.

Hels said...

Hank

tearing down of statues of important people from the past is always problematic. If those old statues were then kept in a museum, with up-to-date reference notes on the wall, I think art historians would be happier.

Hels said...

Hank

a lot of professionals and tradesmen complained of losing trade, and reputation, because of computer graphics. I think this complaint will become even louder with AI.

Hels said...

Erika

Until there were anatomical examinations of peoples' organs and photographs of their faces and bodies, artists did their best to create realistic illustrations. As a result, some of them were very weird indeed!